ABSTRACT
Cutaneous melanoma is the third most common type of skin cancer in the world. The incidence of melanoma is increasing in most countries, however, mortality seems to be slowly decreasing. The treatment of advanced cutaneous melanoma changed radically since 2011. The new therapeutic modalities, such as immuno- and targeted therapies give a chance to successfully reach more prolonged progression-free survival (PFS) and overall survival (OS) in patients with metastatic melanoma. Despite the great therapeutic benefit, most patients eventually develop resistance to these therapies, and the disease will progress. In some cases oligoprogression develops. In those cases local therapy, such as stereotactic radiotherapy can make it possible to continue the previously applied effective medical treatment for the benefit of patients. In our study of a total of 30 patients-20 of them received pre-treatment with systemic medical therapy-received stereotactic radiotherapy using various systems, in the National Institute of Oncology, Hungary, Budapest. We managed to prolong the systemic therapy for 12.5 months median period with the assistance of CyberKnife technique. Therapy related adverse events were mostly tolerable with only 3% of Grade 3 toxicity. We concluded that stereotactic radiotherapy and stereotactic radiosurgery, are safe, and effective therapeutic modalities for regional tumor control in cases of oligoprogression.
Subject(s)
Melanoma , Radiosurgery , Skin Neoplasms , Disease Progression , Humans , Hungary , Melanoma/pathology , Melanoma/radiotherapy , Radiosurgery/adverse effects , Retrospective Studies , Skin Neoplasms/pathology , Skin Neoplasms/radiotherapy , Treatment Outcome , Melanoma, Cutaneous MalignantABSTRACT
Stereotactic radiotherapy gains more and more importance in the management of malignant melanoma, owing to technical developments of recent years. This approach might be applied with success in solitary or oligometastatic cases, since the deliverable biological dose is far higher than that of conventional radiotherapy. Beyond chemotherapy of decreasing importance, there is a widening range of new targeted and immunotherapy agents, leading to longer survival times even in disseminated stages. This latter underlines that it is worth to treat metastatic lesions locally, making this strategy part of present clinical routine. The authors summarize relevant literature of strereotactic radiotherapy in malignant melanoma, and describe related concepts such as oligometastases, abscopal effect or the combination of radiosurgery with modern systemic therapies.
Subject(s)
Melanoma , Radiosurgery , Skin Neoplasms , Humans , Melanoma/pathology , Melanoma/radiotherapy , Melanoma/surgery , Particle Accelerators , Skin Neoplasms/radiotherapy , Skin Neoplasms/surgery , Melanoma, Cutaneous MalignantABSTRACT
The therapy of pancreatic cancer is fundamentally based on surgical removal and chemotherapy. The available evidence and results of publications concerning the application of radiotherapy are controversial. Accordingly, the international guidelines formulated by radiation oncology organizations have paramount interest in this particular pathology. Answers are eagerly awaited in several unclear questions from ongoing, or recently closed, yet unpublished trials. Modern radiotherapy techniques, like stereotactic radiotherapy, or actually less available modalities, like particle therapy or magnetic resonance imaging guided radiotherapy show promising results, as well as combination of radiation with immunotherapy.
Subject(s)
Pancreatic Neoplasms , Radiation Oncology , Humans , Pancreatic Neoplasms/radiotherapyABSTRACT
Lung cancer is known for its outstanding incidence and mortality rates. One of the cornerstones of the treatment of this disease is radiation therapy. A remarkable development was observed in this field through the latest decades. Intensity-modulated and image-guided radiotherapy (IMRT and IGRT) are now widely accessible in Hungarian centers, and should be increasingly applied in case of thoracic irradiations as well. Application of modern radiotherapy techniques in the treatment of lung cancer allows better clinical results and lower rates of side effects. In this work the authors give an overview of this above mentioned development regarding different clinical stages.
Subject(s)
Lung Neoplasms , Radiotherapy, Image-Guided , Radiotherapy, Intensity-Modulated , Humans , Hungary , Lung Neoplasms/radiotherapy , Radiotherapy Dosage , Radiotherapy Planning, Computer-AssistedABSTRACT
The treatment of squamous cell carcinoma of the head and neck is multimodal, including surgery, chemotherapy, and radiotherapy, or the combination of those. Though aggressive treatment results in complete tumor remission in many patients even in locally advanced stages, unfortunately local relapse is not uncommon. For patients not candidate for salvage surgery, chemotherapy and conventional fractionated external beam irradiation can be applied. However, for patients previously treated with full-dose radiotherapy, the deliverable reirradiation dose is limited, considering the elevated risk of toxicity caused by cumulative doses. CyberKnife is a highly conformal radiosurgical technology which can successfully treat this subset of patients. In addition, it can be applied for hardly resectable rare tumors of the skull base and the head and neck region like chordoma, chondrosarcoma and paragangliomas. The CyberKnife stereotacic radiosurgery technology is now available in Hungary, in the National Institute of Oncology.
Subject(s)
Head and Neck Neoplasms/surgery , Radiosurgery/methods , Carcinoma, Squamous Cell/surgery , Humans , Hungary , Neoplasm Recurrence, Local/surgeryABSTRACT
We intend to present the process of implementation of kilovoltage CT-guided volumetric modulated arc therapy (VMAT), and related quality assurance (QA). An Elekta Synergy™ linear accelerator has been installed recently in our institution, equipped with Agility© head, kilovoltage cone-beam CT image guidance and ability of arc therapy. The major steps of the implementation of these techniques and the background of physics QA will be described. Specific dynamic tests have been performed to verify intensity-modulated radiation delivery and the accuracy of on board imaging. Systematic daily, weekly and monthly physics QA protocols have been worked out and applied in the clinical practice. As a result, cone beam CT based image-guided radiotherapy (IGRT) and volumetric modulated arc therapy was introduced in our institution.
